Sensitivity and specificity of general movements assessment for detecting cerebral palsy in an Australian context: 2-year outcomes.

AIM: We previously reported sensitivity and specificity levels of the general movements assessment (GMA) to detect cerebral palsy (CP) at 1 year within a clinical setting and with the assistance of the New South Wales (NSW) Rater Network. The aim of this study was to determine whether similarly high levels of validity could be maintained in the same group at 2 years. METHODS: A prospective longitudinal cross-sectional study was conducted. GMA was blind-rated from conventional video by two independent certified raters, blinded to medical history. A third rater resolved disagreements. High-risk population screening for CP using the GMA during the fidgety period (12-20 weeks) was carried out in four neonatal intensive care units and one CP service over a 30-month period. Participants were 259 high-risk infants for the initial study. Multidisciplinary follow-up at 2-3 years included Bayley Scales of Infant Development and confirmed diagnosis of CP. Sensitivity and specificity values were calculated with true positives defined as a confirmed diagnosis of CP. RESULTS: At 2-3 years, 184 (71%) completed the follow-up assessment. GMA was normal for 134 (73%, low risk for CP), absent fidgety for 48 (26%, high risk for CP) and abnormal fidgety for 2 (1%, high risk for abnormal neurological disorder). Sensitivity for detecting CP was 97.6% (40/41) and specificity 95.7% (133/139). Sensitivity for detecting any abnormal outcome with absent/abnormal fidgety general movements (GMs) was 57.9% (44/76) and specificity 94.4% (101/107). CONCLUSION: Excellent levels of sensitivity and specificity of the GMA for detecting CP in the clinical setting were maintained at 2 years and were similar to our previously reported findings.

Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline.

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.

Local environments and older people's health: dimensions from a comparative qualitative study in Scotland.

Based on the perspectives of older people themselves in three urban neighbourhoods in the Glasgow region of Scotland, this article explores the ways in which the local outdoor physical environment may support or challenge older people's health. Five dimensions are proposed: cleanliness; peacefulness; exercise facilitation; social interaction facilitation; and emotional boost. Consideration is also given to potential equality issues, arguing that such aspects of the local environment may disproportionately affect older people, and also that relevant environmental qualities vary between places. Greater equity and the improved well-being of older people may be achieved through planning and design consideration across sectors.

Place and the experience of air quality.

This article examines how concepts of place effects are relevant in understanding the public's experience of air pollution. Using qualitative and quantitative data from a case study of four neighbourhoods in north London, the analysis shows how this experience is mediated by multiple aspects of place, which may be seen as overlain. These multiple aspects also provide routes to inequalities in the experience of air pollution. Working with these understandings of the relevance of place could provide ways to mitigate the experience of pollution, and to address environmental health inequalities.